Delivering next generations
Maria Garcia de Frutos, Lecturer in Midwifery, City, University of London comments on the psychosocial, economic and political impact of COVID-19 on w...
The Centre for Maternal and Child Health Research carries out high quality research to improve the health and care of women, children, families and communities. The Centre provides an environment for the multi-disciplinary development of ideas and research initiatives in collaboration with professional, voluntary and service user organizations. The Centre has direct links with relevant professional educational programmes at City, University of London, such as midwifery, health visiting, public health and child nursing, which enable the rapid transfer of research into education and healthcare practice.
The Centre has three main research groups:
The themes that draw out of these three research groups are:
Research group lead: Professor Christine McCourt
Our research focuses on evaluating models of maternity, child and family services and care. Our work aims to improve care through rigorous studies using a range of methodologies with an emphasis on evidence-based care, appropriate uses of technology, service change and development and professional and user experience issues. This theme also has a strong inter-disciplinary thread of applying social science concepts and epidemiological approaches to clinical and organisational issues. Much of our work adopts a critical theory perspective and takes account of the complexity of healthcare interventions and contexts.
We are currently involved in a range of research projects and programmes on issues such as implementation of evidence based practice in maternity care, implementing NICE guidance on birth in different settings, factors influencing the uptake of midwifery units, trialling of home monitoring of blood pressure, development and trial of a group model of ante- and postnatal care – Pregnancy Circles (see projects), inter-professional relationships and retention in midwifery and health visiting (COPE study – see projects) and analysis of maternity outcomes by time of day and day of the week. Areas of interest within the group include concepts of choice, risk and safety and their relationship with service delivery and change, professionalisation processes and experiences, gender and healthcare and concepts of motherhood, childhood and the family. Our work is funded by a range of sources, including the National Institute for Health Research, the European Union and the Medical Research Council.
Our findings have been published in high impact journals and presented at conferences around the world. We have established links with a range of user, professional and policy organisations and university departments at local, national and international levels. Our work has influenced the development of maternity services throughout the United Kingdom (UK) and internationally, and has influenced health policy and guidelines in this area.
This research programme, funded by the National Institute for Health Research, is investigating whether giving pregnant women the means to monitor their own blood pressure and urine safely from home, in addition to the usual clinic monitoring, can result in an earlier diagnosis of raised blood pressure and pre-eclampsia. We are also investigating the acceptability and practicality of this approach from women’s and professionals’ viewpoints and any impact on women’s experiences of their pregnancy.
The rationale of this study derives from the reported low percentage of women having their babies in midwifery units (MU) despite the good evidence that suggests for women with uncomplicated pregnancies, having a baby in a MU results in better outcomes and is cheaper in comparison to having a baby on a traditional labour ward. Therefore, this study aimed to explore factors influencing the utilisation of midwifery units (MU) in England. This projected is now completed and findings will be published in 2019. Two articles on aspects of the findings were published in 2018.
The Research for Equitable Antenatal Care and Health (REACH) Pregnancy Circles study is the largest randomized controlled trial of group antenatal care undertaken internationally to date, and is the first to take place in the NHS. It aims to explore whether group antenatal care can improve the outcomes and the wellbeing of mothers and babies and is due to report findings in 2022. City, University of London is involved in the implementation of the trial and is leading on the process evaluation. A number of City Masters and PhD students have worked with the REACH team and City has also developed training in group care facilitation for midwives both as stand-alone workshops and a Masters module.
Hunter L, Da Motta G, McCourt C, Wiseman O, Rayment J, Haora P, Wiggins M and Harden A (2018). 'It makes sense and it works': maternity care providers' perspectives on the feasibility of group antenatal care (Pregnancy Circles). Midwifery 66 (2018) 56-63
Hunter L, Da Motta G, McCourt C, Wiseman O, Rayment J, Haora P, Wiggins M and Harden A (2018). Better together: a qualitative exploration of women’s perceptions and experiences of group antenatal care. Women and Birth 32 (2019) 336–345.
Wiseman O, Hunter L, Robinson H, Leap N, Mackeith N on behalf of the REACH Pregnancy Programme team (2017) Advancing Practice: Facilitating group antenatal care: a new way of working. The Practising Midwife 20(9):18-20
The aim of this project is to enhance collaboration amongst healthcare professionals delivering care for women and their families during and after pregnancy.
This is a study of the feasibility and implications of conducting full-scale randomised controlled trial of an innovative method of induction of labour. Women who are booked for induction are randomised to receive either a prostaglandin pessary or a trans-cervical balloon catheter to start the induction of labour process. The aim is to compare how well these methods of labour induction work, which is the safest and least expensive method, and which is more acceptable to and favoured by women.
As part of this project, a systematic review has also been conducted of women’s experiences of induction of labour:
Coates, R, Cupples, G, Foya V, McCourt C, Scamell M. 2018. Women's experiences of induction of labour: qualitative systematic review and thematic synthesis. Midwifery, 2018-10.
This is a qualitative study involving interviews with healthcare professionals to understand their experiences of working with young mothers. Furthermore, with young mothers to understand their experiences in eating and moving during and after pregnancy.
This study is an observational feasibility study with a nested qualitative study, taking place in antenatal clinics. The aims and objectives of this study are to assess whether it is feasible and acceptable to screen an at-risk migrant population for LTBI at routine antenatal booking visits in secondary care, using opt-out IGRA testing. Secondly, to develop a definitive large scale cluster RCT to evaluate the effectiveness of acceptable interventions to maximise migrant screening for LTBI in pregnancy and to increase uptake of treatment postpartum. Pregnant migrants from high TB-incidence countries will be recruited, collecting data using interviews and focus groups of migrants and LTBI knowledge questionnaires.
Research group lead: Professor Susan Ayers
Our research focuses on the mental health and psychological wellbeing of mothers, their partners and children. Our work has three key areas: risk and resilience factors in perinatal mental health; assessment of perinatal mental health; and innovations in the delivery of perinatal mental health care and treatment.
This multidisciplinary group comprises 8 academic and research staff and 4 doctoral students working on projects ranging from national studies of mental health assessment to international studies of perinatal mental health. Current and recent research includes perinatal mental health in women in low and middle income countries; assessment of birth trauma and post-traumatic stress; evaluations of innovative interventions for perinatal mental health such as peer support interventions and development of local services.
We have established links with NHS Trusts and user-representative organisations in the UK, as well as international links with researchers in Europe, America, and Australasia. This includes the International Network for Perinatal PTSD Research, an international research initiative which is run by members of this group.
This study aims to identify the most effective, acceptable and feasible method for assessing anxiety in women during pregnancy and after birth. This will be achieved through 3 work packages (WP) that compare 4 different tools for assessing anxiety: 2 anxiety-specific measures and 2 mental health measures (GAD-7, SAAS, CORE-10, Whooley questions) selected on the basis of research and clinical evidence that suggest they may be effective. It will be conducted in NHS services in England and Scotland.
This review aims to identify the barriers and facilitators to perinatal mental health assessment, care and treatment for women, at individual, relational (e.g. women-healthcare professional), organisation, and systemic levels; and determine how these can be used to inform and improve perinatal mental healthcare services. This evidence synthesis will be conducted in three phases.
This project aims to identify barriers to service improvement, and to inform and support effective solutions. Consequently, leading to good quality, evidence-based care pathways at the right time for all mums who need it. This project supports local leaders in four sites of England – Blackpool, Haringey, Southend and Gloucestershire, to improve the care and quality of life for mums with mental health problems during pregnancy and the first year of life, and their babies.
Caesareans performed late in labor, where the mother’s cervix is fully open and her baby’s head has entered her pelvis, can be complicated. If the baby’s head is deeply wedged in the woman’s pelvis, it can be difficult to lift it up to enable the baby to be born. This is called an impacted fetal head. There are a number of different techniques that can be used in this situation, however it is not clear which is the best or most effective. This project is looking at whether it would be possible to do a clinical trial to test these different techniques. The research team will conduct surveys and interviews with parents, obstetricians, anesthetists and midwives to gather their views and experiences of these births.
This study involves a group of Australian researchers assisting women with depressive symptoms to increase their physical and mental wellbeing with physical activity.
This is a mixed methods study exploring first time mothers' and fathers' eperiences of fetal imaging (ultrasound and MRI) , and the effect it may have on the developing parent-fetal relationship. Currently in its first year, the project has received funding from the College of Radiographers and the Reseacrh Sustainability Fund at City, University of London. This project is a collaboration between two London universities; bringing together the work of the CMCHR at City, University of London and the Perinatal Imaging Department at King's College London. It is being supervised by Prof.Susan Ayers, Dr.Christina Malamatenious and Prof.Mary Rutherford.
This project started in August 2019 and desired end date is November 2020, funded by Parent-Infant Foundation. Together with Baby is a parent-infant mental health service provided by Essex Partnership University Foundation Trust. We have been funded to evaluate the implementation of this service and answer the question - what factors enable and hinder its implementation? To answer this question, we are conducting a multi-method process evaluation, interviewing numerous stakeholders, clinicians providing the service and families receiving the service. We are also analysing quantitative data such as referral rates and intervention efficacy.
Project Lead at City: Dr Ellinor Olander
Project team members (including links to external partnerships): Dr Rose Coates, Dr Patricia Moran, Professor Susan Ayers
This collaboration with colleagues in Brazil looks at women’s perinatal mental health as part of the Birth in Brazil II Study of 20,000 women giving birth in Brazil. This study will help better understand risk factors, birth factors, and symptoms of depression, anxiety and PTSD in Brazilian women. This collaboration combines City’s expertise on perinatal mental health assessment, birth trauma, models of care and associated outcomes, with Brazilian expertise in perinatal epidemiology, evaluation and surveillance of public health interventions. It will improve understanding of perinatal mental health issues affecting women in Brazil and facilitate recognition and treatment of perinatal mental health problems.
Research Group Lead: Dr Ellinor Olander
Our research focuses on population health, preventive action and health care for women and children including socially and economically marginalised groups, including issues of equity of access to and quality of care. We aim to describe inequalities in maternal and child health outcomes to inform public health policies and improve services for women, children and their families. Research includes young teenage parenting, mothering and feeding children with neurodisability, maternal and child health in relation to HIV/AIDS, and the health of homeless and migrant populations, obesity in pregnancy and in children, sickle cell and female genital mutilation. We are currently working on projects ranging from locally focussed studies in East London to national studies, such as on prevalence of FGM and the timing of birth and its outcome by time of day and day of the week and international comparisons of perinatal indicators. We use a range of methodological approaches including quantitative and qualitative methods and linkage and secondary analysis of national and linked datasets.
We have well established links with Barts Health NHS Trust, Homerton University Hospital NHS Trust and public health departments in East London as well as with the Department of Health, Home Office, the Office for National Statistics and non-governmental organisations such as Maternity Action and the NCT and international networks such as ROAM (Reproductive Outcomes and Migration) and Euro-Peristat. Our work has informed the development of maternal and child healthcare services and policy in England and internationally
This a co-design study, involving 3 groups of people – carers, healthcare professionals and young people, looking at different interventions of sickle cell anaemia. The aim is to develop an intervention to enhance and improve health care provision of sickle cell anaemia.
The general objective is to understand the relationship between medical teams in maternity services and people (users) with a non-western cosmology. The project will illuminate this issue through cross- cultural comparison. In the Brazilian context the focus is on the encounters of indigenous women with health services, while in the UK the focus will be on those of refugees and recent immigrants. A same question will constitute the background of these two studies: how public health policies can account for the cultural diversity in a way that provide adequate care without disrespecting other world logics? The Brazilian part of the research will essentially consist in data analysis of an almost already completed fieldwork, while the UK part will give rise to rapid ethnographic case studies, supplemented by bibliographic and documentary data.
This study aims to improve the way that positive newborn screening results for conditions such as sickle cell disease and cystic fibrosis are communicated to parents by health professionals. With the expansion of newborn screening in England, the importance of delivering screening results appropriately to minimize any long-term negative health and psychological consequences is vital; this project aims to develop interventions to improve such communication. It involves four phases and as a part of the project, the researchers will work with parent representatives for each screened condition covered by newborn screening who will form an advisory group to assist the research team, provide feedback on each phase of the project and monitor its progress.
This study will evaluate child nursing student views and experiences on peer mentoring and understanding how to train them as peer mentors, in addition to assisting them in mentoring other colleagues as well.
This study involves interviewing young people, carers and parents of those diagnosed with sickle cell anaemia to assist in the development of an educational pack for student nurses. This pack should include all necessary information of what a student nurse should know in regards to this illness.
Research Group Lead: Dr Susan Bradley
A developing strand of our work is addressing quality of MCH care globally, including in low and middle-income countries. This strand builds on a series of doctoral projects addressing subjects as diverse as HIV, female genital mutilation, health system stewardship, maternal health and respectful maternity care. Our work is now focused on the implementation of high quality and respectful care, goals that are now reflected in World Health Organisation policies and in the Sustainable Development Goals. We explore how structural factors and the organisation and models of care can influence maternal and child health and wellbeing, positively or negatively. We are focused on translation of international evidence on the value of midwife-led care in a range of contexts. Aspects of our work also bring lessons for improving maternal health and care from low-income countries to higher income settings like the UK, through community-based interventions and women’s groups – for example in models such as group care (see projects).
Recent support from the Global Challenge Research Fund has enabled us to:
We draw on critical realist approaches, post-colonial and de-colonising theories to provide a critical analysis of the forces influencing quality, safety and experience of care, including cultural safety. We also use implementation science theory to inform our thinking about how to implement change, but with a strong focus on social and structural approaches which take into account the
This is a Horizon 2020 project funded by the European Commission. It aims to develop a systematic and in-depth understanding of acceptable, feasible and sustainable strategies to integrate group care into health systems for antenatal and postnatal care during the first 1000 days. It will use demonstration sites in 4 LMICs (Ghana, Suriname, South Africa, Kosovo), and 3 high-income countries (The Netherlands, Belgium, UK). GC_1000’s focus is on setting the groundwork for sustained service delivery, creating country-specific blueprints for scale-up, and using cross-country synthesis to develop a global implementation strategy toolbox. The toolbox will encourage adaptation, implementation and scale up of facilitated group care within the first 1000 days, particularly to reach the most vulnerable groups of women and girls globally.
This is an on-going research and development programme to test whether the introduction of midwifery units (MUs), staffed by dedicated midwives, can improve the birth environment and experience of care for women and midwives in low- and middle-income countries (LMIC). IMaGINE focuses on the potential of midwifery-led care and services to address the complex, multi-faceted problems of widespread disrespect and abuse during birth, lack of evidence-based practice, and women’s reluctance to engage with facility-based birth. While we have robust evidence from high-income countries on the benefits of midwife-led care models (for women and midwives), such evidence is lacking from resource-constrained contexts. The initial stages of our programme were supported by Global Challenge Research Funding. This enabled us to establish a network of actors from Malawi, Sudan, Brazil and India and to work together to carry out a systematic review/ meta-synthesis of current evidence on the impact of midwifery units in LMICs. We have also undertaken key stakeholder workshops and situational analyses in three of the four partner countries. Future plans involve identifying pilot project sites to carry out implementation and evaluation of MUs in these contexts.
This is an ethnographic study, exploring the complexity of social processes on decision-making related to the universe of meanings, reasons, beliefs, values and attitudes that influence women’s birthplace choice.
This project involves collaboration with colleagues at the Oswaldo Cruz Foundation (Fiocruz) in Brazil. It is forms part of a wider study to look at women’s perinatal mental health as part of the Birth in Brazil II Study of 20,000 women giving birth in Brazil. This study, funded by the Newton Fund, will help better understand risk factors, birth and care factors, and symptoms of depression, anxiety and PTSD in Brazilian women. The Birthplace in Brazil study, funded by the Grand Challenges Research Fund enables us to look specifically at outcomes of births planned in freestanding midwifery units in Brazil. Development of midwifery units (Centros de Parto Normal) formed a key part of the maternity reform policy in Brazil, to improve outcomes and experiences of care and reduce the excessive rates of intervention. However, only a small number have been implemented to date and these are mainly concentrated in a few cities. This study will help to provide evidence which should increase confidence in implementation across Brazil.
Researchers at City: Dr Nathalie Leister, Dr. Rose Coates, Dr. Louise Williams, Prof. Christine McCourt, Prof. Susan Ayers
Partners: Friocruz, Brazil
City, University of London has formed a partnership with a Brazilian institution. This project is exploring maternity care in Brazil including a national survey of obstetric units, midwifery units and surveying over 20000 women.
This study explored midwives’ perspectives on the practice, impact and challenges of delivering respectful maternity care in Malawi, highlighting the considerable challenges facing staff in this context. Prior to this, much of the research had focussed on women’s experiences. This work aimed to include the voice of the midwife.
Two systematic reviews were conducted to understand the broader drivers of disrespectful care during birth in sub-Saharan Africa. One explored women’s experiences; the second focussed on midwives perspectives.
This study aims to show the optimum maternal and perinatal outcomes in Midwifery Units, explore the reasons for why majority of women with uncomplicated pregnancies give birth in obstetric units when there is no clinical indication and the reasons behind choosing this environment against the evidences on places of birth.
Research Group Lead: Dr Lucia Rocca-Ihenacho
The Midwifery Units (MU) Standards were developed by a team led by Dr Rocca-Ihenacho as part of her NIHR Knowledge Mobilisation Fellowship, thus being translational. The aim of the standards was to support the implementationof the evidence produced by our prior research on place of birth and particularly to support maternity units planning to open new MUs or improving existing ones.
The MU Standards were launched during the second MUNet Conference at City in July 2018 and we now want to develop indicators and an assessment tool in order to further develop impact. The Standards document includes 27 standards under 10 themes that capture the evidence base, translating it into more practical guidance. At present the Standards do not include indicators for users to benchmark where their service is in relation to the Standards or any improvements achieved. The number of indicators is expected to be approximately 50.
We propose to create indicators and a self-assessment tool for users to assess their own services against each of the published Standards. This can also hold future income generating opportunities for MUNet in terms of creating an accreditation system.
The aim of this study is to develop and evaluate a theoretically informed knowledge implementation pathway that service providers and commissioners can use as a guide to implement evidence on birthplace into NHS services which require complex organisational and professional practice change.
This study has been completed and is in the analysis stage.
Professor Susan Ayers
Dr Katherine Curtis-Tyler
The Centre hosts research seminars regularly as part of the School of Health Sciences’ weekly research seminar programme. All are welcome to attend but it is essential to contact the organiser beforehand for room and catering planning and in case of any late changes or cancellation. We will aim to make presentations or podcasts available on the website where possible.
A time to be born
8th and 9th September 2020
University of Chester
5th May 2020
Visit Midwifery Unit Network Facebook group for link to join
11th June 2020
4th and 5th November 2019
Implementing Midwifery Units in Europe: a multidisciplinary effort
5th and 6th of September 2019
City, University of London
The Society for Reproductive and Infant Psychology (SRIP) is an international organisation bringing together research on psychological, socio-cultural and political aspects of reproduction, birth and infancy. The Society raises awareness of psychological, social and political aspects of reproductive and infant health through scientific conferences and workshops, our journal The Journal of Reproductive & Infant Psychology, and liaising with professional bodies and the public.
Our annual conferences provides the means to exchange research findings, develop research interests, develop research networks and engage with clinical and academic partners.
Took place on 20th July 2017.
This conference aimed to share research and experiences related to positive birth. Featuring a number of high profile speakers and guests from the area, the day shared some of the latest research from the discipline as well as service users’ experiences in order to explore the concepts of positive birth and informed choice. The event was organised by Judith Flood, a midwifery lecturer in the School of Health Sciences at City.
Midwifery Unit Network Conference (MUNet) 2018
Took place on 10th July 2018.
At the conference, Dr Lucia Rocca-Ihenacho and colleagues launched the Midwifery Unit Standards developed as part of an NIHR post-doctoral fellowship at City, University of London. The Standards have been developed over an 18 month period by a team of researchers with input from a broad range of stakeholders across the UK and mainland Europe, RCM, EMA and delegates at the 2017 ICM conference.
They celebrated Birth Centre Beacon Sites and certificates were presented by Kathryn Gutteridge, President of the Royal College of Midwives.
Leading midwives and policymakers from all four countries of the UK presented on making services more responsive to women's and babies' needs, more family-friendly, and unlocking the potential of birth centres.
In collaboration with the Royal College of Midwives, the Midwifery Unit Network offers support to those wishing to develop midwifery units (birth centres), and to already established midwifery units. The network acts as a hub to share good practice and information resources, and be a community of practice with a shared philosophy essential to offer consistent, excellent and safe care for women and their families.
The aim of the Midwifery Unit Network is to maximise potential for a positive childbirth experience, and to enhance the physical and psychological wellbeing of childbearing women and their babies, through the promotion and support of midwifery units (birth centres).
This is a network of researchers and clinicians who are working together to reduce birth trauma and perinatal PTSD across the world.
The website provides information on the latest perinatal PTSD research, events, and an interactive blog where researchers can interact and post questions. The latest research papers on perinatal PTSD are posted monthly.
The Centre runs a Patient and Public Involvement group where parents and parents-to-be collaborate on research projects. To date, parents have helped develop questionnaires, participant recruitment strategies and grant proposals.
Professor Debra Salmon
We have a range of questionnaires and research tools that are freely available to download or use on request. These include:
City Infant Faces is a database of standardised photographs of baby faces showing different emotions. These have been categorised into positive, negative and neutral emotions and can be used in studies of the perception of infant emotions. The City Infant Faces database has been validated and is available on request for research use only (contact us).
The CityBiTS is a questionnaire measure of post-traumatic stress disorder (PTSD) after birth. This questionnaire measures symptoms and diagnosis of PTSD according to DSM-5 diagnostic criteria. It also includes items from DSM-4 that research suggests are discriminative when diagnosing postnatal PTSD. Available on request (contact us).
The CityMISS is a questionnaire measure of perceived stigma for mental illness in pregnancy and postpartum. It is available on request (contact us).
The SCIB measures control during birth and perceived support from health professionals. It has 3 subscales: support from healthcare professionals, perceived internal control, and perceived external control. Validated versions are available in English, German and Turkish:
SCIB – English version
SCIB – German version
SCIB – Turkish version
The P-BESS measures experiences and satisfaction with care during the birth of a preterm baby. It can be used with mothers and fathers. Validated versions are available to download in English. A Portuguese version is currently being validated so will be available soon.
P-BESS English version
The BirthMARQ measures women’s memories of birth and aspects of recall. It has 5 subscales of: (1) emotional memories, (2) centrality of memories to self, (3) coherence of memories, (4) reliving of memories and (5) recall of memories. Validated versions are available to download in English. Persian and Czech versions are currently being validated so will be available soon.
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